Effect of Althesin on Cerebral Perfusion, Cerebral Metabolism and Intracranial Pressure in the Anaesthetized Baboon

Pickerodt, V. W. A.; Mcdowall, D.G.; Coroneos, N. J.; Keaney, N. P.

doi:10.1093/bja/44.8.751

Cited by 57 publications

(16 citation statements)

References 4 publications

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“…Althesin is a steroid compound with short-lasting anaesthetic properties. Experimentally it has been found to cause a marked CMRo 2 reduction and a concomitant clear-cut vasoconstriction (Pickerodt et al, 1972). A further increase of the dose will cause a further CBF decrease, but simultaneously a marked hypotension will be induced.…”

Section: Althesinmentioning

confidence: 97%

Physiology of Cerebral Blood Flow

Lassen

Christensen

1976

British Journal of Anaesthesia

286

104

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Section: Althesinmentioning

confidence: 97%

Physiology of Cerebral Blood Flow

Lassen

Christensen

1976

British Journal of Anaesthesia

286

104

View full text Add to dashboard Cite

“…[1,4,7,9,12,16,21,22,[24][25][26][27]37,39,40,43,[46][47][48]50,[53][54][55][56] With the exception of that found for barbiturates, strong evidence does not exist for the protective ability of these other agents. [1,7,9,12,25,26,35,37,38,40,43,[53][54][55][56] In particular, the purported ability of ISO to guard against neural damage is very controversial. Clinical and experimental studies have demonstrated both the presence and absence of histological protection and improved neurological outcome with the use of ISO in the setting of ischemia.…”

mentioning

confidence: 99%

Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery: time limitation and advantage of brain protection

Lavine¹,

Masri²,

Levy³

et al. 1997

FOC

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The risk of focal infarction secondary to the induced reversible arrest of local arterial flow during microsurgical dissection of middle cerebral artery (MCA) aneurysms was evaluated further to define the optimal approach to temporary arterial occlusion. To compare the effectiveness of brain-protection anesthetics, a group of patients treated with the intravenous agents, propofol, etomidate, and pentobarbital, administered individually or in combination, was compared to a group treated with the inhalational agent isoflurane. Forty-nine consecutive MCA aneurysm surgeries involving the temporary clipping of the parent vessel were retrospectively reviewed. Thirty-eight patients received intravenous brain-protection (IVBP) anesthesia. Groups of patients with and without infarctions, and receiving and not receiving IVBP, were compared based on the duration and nature of temporary arterial occlusion. Postoperative radiographic evidence of new infarction was used as the threshold for failure of occlusion tolerance. The overall infarction rate was 22.4% (11 of 49 patients), including 15.8% (six of 38 patients) in the IVBP group versus 45.5% (five of 11 patients) in the isoflurane (ISO) group. In the ISO group, the mean duration of temporary occlusion was 3.9 ± 2.2 minutes for patients without infarction versus 12.2 ± 4.3 minutes for patients with focal infarction (p < 0.01). In contrast, the mean duration was 13.6 ± 10.6 minutes for patients without infarction and 18.5 ± 9.9 minutes for patients with infarction in the IVBP group. All patients in the ISO group who underwent occlusion lasting 10 minutes or longer suffered an infarction versus five of 23 patients in the IVBP group. Patients with multiple aneurysms were found to be at increased risk of developing focal infarction, whereas those treated with intermittent temporary clip application were at a decreased risk. It is concluded that patients in whom focal iatrogenic ischemia is induced during MCA aneurysm clip ligation have a significant advantage compared with those receiving ISO when they are given pentobarbital as the primary neuroprotective agent or when they receive propofol or etomidate titrated to achieve electroencephalographic burst suppression, particularly if more than 10 minutes of occlusion time is required. It is also concluded that 10 minutes is a general guideline for safe, temporary occlusion of the MCA. The use of intermittent temporary arterial occlusion and patients with multiple aneurysms need further evaluation before specific recommendations can be made.

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“…Anaesthesia by the slow i.v. infusion of Althesin avoided the major, transient changes (in arterial pressure, for example) that complicate single bolus injections in baboons (Pickerodt et al, 1972) and in man (Savege et al, 1971). However, information regarding cerebral blood flow and oxygen consumption at these light levels of anaesthesia is not available for the infusion of Althesin in spontaneously breathing subjects.…”

Section: Discussionmentioning

confidence: 99%

E.E.G. Monitoring for the Control of Anaesthesia Produced by the Infusion of Althesin in Primates

Prior

Maynard

Brierley

1978

British Journal of Anaesthesia

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The continuous infusion of Althesin under electroencephalographic (e.e.g.) control provided a constant level of light anaesthesia for periods of 1--5.5 h during experimental brain hypoxia in spontaneously breathing baboons and Rhesus monkeys. Polygraphic records (respiration, heart rate, arterial pressure, cerebral venous sinus pressure, end-tidal gas concentrations) and also estimation of blood-gas tensions, pH, and concentrations of pyruvate and lactate demonstrated a steady physiological state. Various methods of e.e.g. monitoring were tested to establish an optimal assessment of depth of anaesthesia as a guide to the control of the rate of infusion of Althesin. A purpose-built modification of the Cerebral Function Monitor was found to give unequivocal recognition of changing depths of anaesthesia.

show abstract

Effect of Althesin on Cerebral Perfusion, Cerebral Metabolism and Intracranial Pressure in the Anaesthetized Baboon

Cited by 57 publications

References 4 publications

Physiology of Cerebral Blood Flow

Physiology of Cerebral Blood Flow

Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery: time limitation and advantage of brain protection

E.E.G. Monitoring for the Control of Anaesthesia Produced by the Infusion of Althesin in Primates

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